Introduction

Chemical restraint can be used for a variety of reasons: for control of a violent individual or the agitated patient, to disperse crowds (crowd-control agents), or to limit access to specific areas. This type of control has also been used by criminals to subdue the individual in acts such as rape, robbery, and murder. The possibilities are vast, and detection of their use can be obvious, such as that with traditional tear gas or pepper spray, or may take forensic testing in cases where the person was sedated or otherwise drugged.

Forms of chemical restraint were used as early as 423 bc in the Peloponne-sian war. Modern chemical crowd-control agents were first employed in the early months of World War I, when the French launched tear gas grenades against the German army. In addition to chlorobenzylidene (tear gas). World War I also saw the introduction of chlorine gas and mustard gas. The Germans first used chlorine gas in the spring of 1915 against the French Army at Ypres. The chlorine gas formed a cloud that was mistaken as a smoke screen behind which the German Army would advance. Instead of evacuating the area, the French army entrenched itself, readying for an attack. Mustard gas was used in 1917 by the German army against the French army. Unlike chlorine, which wafted in a cloud described as a greenish-yellow smoke, mustard gas was nearly odorless, and its effects took much longer to manifest. Although chlorine was an immediate choking agent, rendering severe respiratory distress and death, the full effects of mustard gas take 12-24 hours. Because mustard is an oily substance, it persists in the environment in which it is released, extending its

From: Clinical Forensic Medicine: A Physician's Guide, 2nd Edition Ed i ted by: M. M. Stark © Humana Press Inc., Totowa, NJ

exposure. Any surface exposed to mustard gas is affected. Mucosal membranes, such as the eye, respiratory tract, and skin, develop blisters, slough, and can fully incapacitate the individual for long time periods. It should be noted that the term gas may not be completely correct because many of these agents are not true gases but rather are solid particles that can be dispersed. The effectiveness of the crowd-control agent depends on the delivery of adequate amounts and sufficient contact with susceptible surfaces so that the desired effect is achieved. Therefore, temperature, wind conditions, method of delivery, formulation and potential barriers (such as clothing, masks, and eye protection), and ability to decontaminate interject variability into the response.

World War I was the first modern forum that tested chemical weapons to control large numbers of individuals. Since then, agents with wider safety margins have been developed that promote dispersal of large numbers of individuals without significant morbidity and mortality. Modern crowd-control agents, such as chlorobenzylidene ([CS]; also known as tear gas), were first used by the military as training agents, then by law enforcement as alternatives to lethal force, and most recently, some have become available to civilians for personal self-defense. Chemical crowd-control agents can also be used by terrorists to incite fear or panic in crowds, and there is always the potential for accidental dispersal in a public forum or, rarely, the potential for self-abuse.

There is considerable debate concerning the use of chemical agents for crowd control. Three agents have been used as less lethal alternatives to firearms and batons. They are capsaicin oleum (OC) (also known as pepper spray [PS]), chloracetothenon ([CN]; also known as mace), and CS.

There are five major concerns about the use of these agents by law enforcement:

1. Their possible toxicity to the offender.

2. Potential for exposure to the person administering the agent.

3. The potential for any ancillary exposure to health care providers, and to bystanders (1-4).

4. The expansion of their use to nonviolent offenders, such as peaceful protesters.

5. Concern about the long-term effects from repeated exposure and from occupational exposure (5).

Some of these issues become more complicated because chemical control agents are increasingly popular with civilians as readily available, often legal, self-defense weapons.

There have been several incidents in the United States and in other countries that question the appropriateness of use of chemical crowd-control agents (5,6). In one reported incident in the United States, law enforcement officers applied OC liquid via a cotton-tipped applicator directly to the periorbital area

Table 1

Examples of Chemical Restraint Products Available

Brand name

Ingredients

Delivery system

Cap-Stun

Alan's Pepper Spray Pepper Foam

Pepper Gard, Triple Action Spray Mark III

Spray Spray

Foam spray

OC, capsaicin oleum; CS, chlorobenzylidene.

of protesters who were sitting and refused to disperse (7). The use of OC against these nonviolent offenders when other methods of control failed generated negative publicity and resulted in legal action against the law enforcement officials.

When used appropriately, crowd-control agents have a good safety margin and generally do no permanent harm. In addition to the furious debate over the agents, there has been some concern over the safety of the delivery vehicles, particularly methyl-isobutyl ketone (MIBK). Although chronic exposure to MIBK has been associated with neurological and respiratory effects, there are no data to support the theory that acute exposure to the low concentrations that occur with CS spray poses these same problems (8-10). Despite all of the controversy surrounding chemical control agents, they offer a less hazardous method of restraint than other potentially lethal alternatives, such as firearms.

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